Who was first to diagnose and report neuropathic arthropathy of the foot and ankle: Jean-Martin Charcot or Herbert William Page?

In November 1883, Jean-Martin Charcot and Charles Féré reported on bone and joint disease of the foot in cases of tabes dorsalis, and referred to the condition as 'pied tabétique'--a disabling neuropathic osteoarthropathy that we usually now refer to as the Charcot foot. Charcot had originally described neuropathic osteoarthropathy in more proximal joints in 1868, and in his 1883 paper with Féré stated that involvement of the short bones and small joints of the foot had not yet been described. They emphasised in the paper that one of their cases was the first ever observed, two years earlier, in 1881. It is relevant, however, that it was in this same year that involvement of the foot by tabetic arthropathy was presented to the International Medical Congress in London by an English surgeon, Herbert William Page. We believe that Page was the first to diagnose and to report a case of tabetic neuropathic osteoarthropathy in which the bones of the foot and ankle were involved. He was also the first to propose a link between the tabetic foot and disease of the peripheral nerves, as opposed to the central nervous system.

History of the team approach to amputation prevention: pioneers and milestones.

BACKGROUND: This historical perspective highlights some of the pioneers, milestones, teams, and system changes that have had a major impact on the management of the diabetic foot during the past 100 years. In 1934, American diabetologist Elliott P. Joslin noted that mortality from diabetic coma had fallen from 60% to 5% after the introduction of insulin, yet deaths from diabetic gangrene of the lower extremity had risen significantly. He believed that diabetic gangrene was preventable. His remedy was a team approach that included foot care, diet, exercise, prompt treatment of foot infections, and specialized surgical care. RESULTS: The history of a team approach to management of the diabetic foot chronicles the rise of a new health profession, Podiatric Medicine and Surgery, as well as the emergence of the specialty of Vascular Surgery. The partnership between the diabetologist, vascular surgeon, and podiatrist is a natural one. The complementary skills and knowledge of each can improve limb salvage and functional outcomes. Comprehensive multidisciplinary foot care programs have been shown to increase quality of care and reduce amputation rates by 36% to 86%. The development of distal revascularization techniques to restore pulsatile blood flow to the foot has also been a major advancement. CONCLUSION: Diabetic foot patients are among the most complex and vulnerable of all patient populations. Specialized diabetic foot clinics of the 21st century should be multidisciplinary and equipped to coordinate diagnosis, off-loading, and preventive care; perform revascularization procedures; aggressively treat infections; and manage medical comorbidities.

History of the team approach to amputation prevention: pioneers and milestones.

This historical perspective highlights some of the pioneers, milestones, teams, and system changes that have had a major impact on management of the diabetic foot during the past 100 years. In 1934, American diabetologist Elliott P. Joslin noted that mortality from diabetic coma had fallen from 60% to 5% after the introduction of insulin, yet deaths from diabetic gangrene of the lower extremity had risen significantly. He believed that diabetic gangrene was preventable. His remedy was a team approach that included foot care, diet, exercise, prompt treatment of foot infections, and specialized surgical care. The history of the team approach to management of the diabetic foot chronicles the rise of a new health profession-podiatric medicine and surgery-and emergence of the specialty of vascular surgery. The partnership among the diabetologist, vascular surgeon, and podiatric surgeon is a natural one. The complementary skills and knowledge of each can improve limb salvage and functional outcomes. Comprehensive multidisciplinary foot-care programs have been shown to increase quality of care and reduce amputation rates by 36% to 86%. Development of distal revascularization techniques to restore pulsatile blood flow to the foot has also been a major advancement. Patients with diabetic foot complications are among the most complex and vulnerable of all patient populations. Specialized diabetic foot clinics of the 21st century should be multidisciplinary and equipped to coordinate diagnosis, off-loading, and preventive care; to perform revascularization procedures; to aggressively treat infections; and to manage medical comorbidities.

What lessons can history teach us about the Charcot foot?

Regrettably, physicians today receive very little instruction in the history of medicine. Most health care providers have a very limited, contemporary knowledge of the condition that we know of as the Charcot foot. Yet, historical concepts of the pathogenesis and natural history of this condition provide us with important lessons that enhance our understanding, recognition, and management of this rare but debilitating neurogenic arthropathy. It is my belief that knowledge of the history of medicine provides us with a better understanding of present-day issues and clearer vision as we look to the future. This article describes some of the important lessons learned from the history of the Charcot foot.

The Charcot foot: historical perspective 1827-2003.

Charcot's joint disease of the foot and ankle is a poorly understood and frequently overlooked complication of diabetes. Recognition of this condition, especially in its earliest stage, remains problematic, with many cases going misdiagnosed even today. Medical management of the Charcot foot remains the standard of care for the majority of patients, with surgical intervention reserved for the most difficult cases. This historical perspective began in the early nineteenth century with the first attempts to experimentally examine the spinal origin of rheumatism of the foot and ankle. J.-M. Charcot was the first to describe the arthropathies associated with tabes dorsalis. His early investigations into the tabetic arthropathies (1868) and his brilliant presentation, Demonstration of Arthropathic Affections of Locomotor Ataxy, at the 7th International Medical Congress (1881), established this disease as a distinct pathological entity. Charcot and Féré published the first observations of the tabetic foot (Pied tabétique) in the Archives de Neurologie in 1883. It was not until 1936, however, that W. R. Jordan established the association between neurogenic arthropathy of the foot/ankle and diabetes mellitus.

Jean-Martin Charcot (1825-1893). The man behind the joint disease.

Jean-Martin Charcot was one of the most celebrated French physicians of the 19th century. A masterful teacher and a captivating lecturer, Charcot created the foundations of neurology as an independent discipline, and transformed the Salpêtrière hospital, in Paris, into one of the world's greatest teaching centers for clinical neurologic research. His name is attached to the distinct pathologic entity, Charcot's joint disease, that he so meticulously described. This article reviews the highlights of Charcot's career and his clinicoanatomic studies of patients with tabetic arthropathies.